HYPERTROPHIED COLUMNS OF BERTIN (also known as “Septa of Bertinâ€)
Prominent (or hypertrophied) columns of Bertin (also known as “Septa of Bertinâ€) is the normal variant of the kidney formed of hypertrophied cortical tissue located between the pyramids that projects into the renal sinus, resulting in splaying of the sinus. Hypertrophied but otherwise normal renal tissue not only distorts the renal sinus but can also results in disorganized calyces which can be very well demonstrated on excretory urography and CT urography because the papillae are not situated in the typical radial orientation.
Columns of Bertin are usually located in the middle third of the kidney, more commonly in the left kidney than the right.
IMAGING FEATURES
Ultrasonographic features:
Ultrasonographic features:
1) Indentation on the renal sinus by the lesion.
2) Splitting of the sinus.
3) Well defined and distinct from the renal sinus, in continuity with the adjacent renal cortex with similar echogenicity as that of the adjacent renal cortex.
4) Engulfment of the papilla and cortical projection due to extension of the junctional parenchyma medially in the kidney.
5) A true columns of Bertin appears more echogenic than the normal renal cortex as a result of the anisotropic effect.
Patients with an atypical sonographic appearance or unusually large and prominent columns (septa) of Bertin are usually followed up with contrast enhanced CT or MRI
CT Features:
Prominent columns (septa) of Bertin shows enhancement (perfusion) to be similar to that of the surrounding renal parenchyma on CECT
Prominent columns (septa) of Bertin shows enhancement (perfusion) to be similar to that of the surrounding renal parenchyma on CECT
Renal pseudotumors are the masses that are composed of normal or benign renal tissue.
Types of Renal Pseudotumors
Developmental
Developmental
Prominent columns (septa) of Bertin
Persistent fetal lobulation
Dromedary hump
Splenorenal fusion
Cross fused renal ectopia
Infectious
Abscess
Pyelonephritis
Scarred kidney
Granulomatous
Xanthogranulomatous pyelonephritis
Sarcoidosis
Malakoplakia
Tuberculosis
Vascular
Extramedullary hematopoiesis
Arteriovenous malformation
Renal pelvic hematomas
Anticagulant induced subscapular hemorrhage
Miscellaneous
Regenerating nodule after reflux